The Absolute Discharge for Vince Li was wrong

Vince Li has been treated now, for his schizophrenia, for 8 years. He has been living in the community and attending classes. The Review Board has given him an “absolute discharge”. He is, we are told, recovered, insightful, remorseful, and willing to take his medication regularly. Thus he is not a threat and qualified for absolute discharge.

He may well remain healthy and compliant with his medication for the rest of his life.

Perhaps the odds are slight that he will stop his medication and become ill again.

But, here are two realities about psychotic illnesses, schizophrenia in particular:It is hard to catch a relapse.

When a patient stops his medication he will feel fine for a while. And when the relapse begins the first thing to become impaired is insight. One can monitor mood, but not one’s own cognitive processes. So very few people with schizophrenia who stop medication and feel good for a while, are then able to detect, on their own, the early signs of cognitive changes. As the illness worsens the prospect of insight lessens. It is the nature of schizophrenia. It affects thinking.

When relapses of psychotic illnesses occur, the original delusion returns, if not exactly word for word, almost word for word. Thus if the original delusion was relatively harmless, in a relapse the patient’s returning delusion will be relatively harmless. “They are listening to my thoughts from the TV so I don’t ever turn it on.” “It is happening again.” But if the original delusion was dangerous: “I must kill to rid the world of the devil”, then when the relapse occurs the person in question will once again become dangerous.

Thus, even if the possibility of a relapse of illness for Mr. Li is small, such a relapse would be far more dangerous than for most people with this illness.

And if this occurs, if Mr. Li relapses and hurts or kills someone else, the cost will be much wider than Mr. Li and his victim. “Let’s talk about it” will certainly not be enough to reduce stigma then.

Such an occurrence will undermine the compassion and civility of the “not criminally responsible” finding.

The average citizen has trouble buying this defense now, for various reasons, especially when the crime is horrifying. If Mr. Li relapses and commits a crime, the community outcry will be very strong. A relapse and repeat by Mr. Li could thus do great harm to all mentally ill in Canada.

This could have been remedied simply: a discharge (though not absolute) that continued a lifetime of monitoring compliance with treatment. Not overly intrusive or restrictive. Simply making sure that Mr. Li continues his treatment, that he continue to take his pills every day or his injections every two weeks.

If Mr. Li stops taking his anti-psychotic medication, one year or ten years from now, the illness will relapse. And the delusions of this illness always return in the same form.

7 thoughts on “The Absolute Discharge for Vince Li was wrong”

Thank you for this wisdom Sad to say Mr Summerville CEO Manitoba Schizophrenia Society and CEO of Canadian Schizophrenia who has been counselling and befriending Mr Li over many years seems to ignore the issue of relapse and how quickly insight is lost. Has he ever listened to what families would advise on this matter? Also he does not address the nature of the hallucinations which led to the death of Tim Maclean and the reality that should they return they would be in a similar form . He likes the word “Recovery” rather than “stabilization”i. The latter i prefer.

t seems to me. Dr Haag the doctor involved with Mt Li speaks of a recidivism rate of 11 percent over 35 years (i.e.according to his study) and the fact that there is a very high threshold for unconditional discharge. It should be far more important to concentrate on the nature of the delusions and how they might come back in a similar form. Sensible monitoring should not be seen as a punishment just a safe precaution to protect both the public and Mr Li

I understand that legal dilemma but it is easily solved by the hospital not “discharging” a patient but transferring care to the outpatient department and remaining under the ultimate responsibility of the NCR Review Board with a restriction limited to monitoring compliance with treatment.

Alas there should be provisions given the nature of the delusions. Once again the medical profession and the legal profession lock horns . beverley maclachlan had dissenting views on a particular case regarding this matter.

Thank you Dr Dawson. I am convinced by your medical knowledge and evidence that patients with a history of violence must be given conditional discharges so that they can be easily re apprehended and treated if they relapse.